CMS Formulary

Displaying 120391-120400 of 1611142 results.
ID: 120391
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1552004
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 120392
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1723478
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 120393
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1430453
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120394
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1430457
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120395
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1100706
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 120396
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1430449
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120397
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1592748
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 120398
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1592752
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 120399
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1243033
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 120400
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1243040
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30